Provider Demographics
NPI:1841912458
Name:BAYERL, GEORGIA RUTH (LLMSW)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:RUTH
Last Name:BAYERL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 FIVE OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-374-8066
Mailing Address - Fax:
Practice Address - Street 1:4287 FIVE OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-882-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2023-10-03
Deactivation Date:2023-09-26
Deactivation Code:
Reactivation Date:2023-10-03
Provider Licenses
StateLicense IDTaxonomies
MI68511172061041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician